Insulin Resistance (cont.)

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Robert Ferry Jr., MD

Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.

What medical conditions are associated with insulin resistance?

While the metabolic syndrome links insulin resistance with abdominal obesity, elevated cholesterol, and high blood pressure;
several medical other conditions are specifically associated with insulin
resistance. Insulin resistance may contribute to some of the conditions listed.

Type 2 Diabetes

Overt diabetes may be the first sign that insulin resistance is present. Insulin resistance can be noted long before type 2 diabetes develops. Individuals reluctant or unable to see a health care
practitioner regularly often seek medical attention when they have already developed type 2 diabetes and insulin resistance.

Fatty liver

Fatty liver is strongly associated with insulin resistance. Accumulation of fat in the liver is a manifestation of the disordered control of lipids that occurs with insulin resistance. Fatty liver associated with insulin resistance may be mild or severe. Newer evidence suggests that fatty liver may even lead to
cirrhosis of the liver and, possibly, liver cancer.

Arteriosclerosis

Arteriosclerosis (also known as atherosclerosis) is a process of progressive thickening and hardening of the walls of medium-sized and large arteries. Arteriosclerosis is responsible for:

Skin Lesions

Skin lesions include increased skin tags and a condition called acanthosis nigricans (AN). Acanthosis nigricans is a darkening and thickening of the skin, especially in folds such as the neck, under the arms, and in the groin. This condition is directly related to the insulin resistance, though the exact mechanism
is not clear.

Acanthosis nigricans is a cosmetic condition strongly associated with insulin resistance in which the skin darkens and thickens in creased areas (for example, the neck, ar pits, and groin).

Skin tags are occur more frequently in patients with insulin resistance. A
skin tag is a common, benign condition where a bit of skin projects from the surrounding skin. Skin tags vary significantly in appearance. A skin tag may appear smooth or irregular, flesh colored or darker than surrounding skin, and either be simply raised above surrounding skin or attached by a stalk (peduncle) so that it hangs from the skin.

Hyperandrogenism: With PCOS, the ovaries can produce high levels of the hormone testosterone. This high testosterone level can be seen with insulin resistance and may play a role in causing PCOS. Why this association occurs is unclear, but it appears that the insulin resistance somehow causes abnormal ovarian hormone production.

Growth abnormalities

High levels of circulating insulin can affect growth. While insulin's effects on glucose metabolism may be impaired, its effects on other mechanisms may remain intact (or at least less impaired). Insulin is an anabolic hormone which promotes growth. Patients may actually grow larger with a noticeable coarsening of features. Children with open growth plates in their bones may actually grow faster than their peers. However, neither children nor adults with insulin resistance become taller than predicted by their familial growth pattern. Indeed, most adults simply appear larger with coarser features. The increased incidence of skin tags mentioned earlier may occur through this mechanism too.